Drug company that offered to buy TVs for eye clinic did not exert ‘excessive’ influence, report finds

A newly released report paints a rare picture of the close relationship between a drug company and a major Canadian university’s ophthalmology department, with Novartis supplying “kitbags” of sample drugs to patients, offering to buy TVs and sponsored videos for a clinic waiting room, and funding guest speakers, journals and education.

Some of Dr. William Hodge's allegations, and the lawyer’s findings

• Novartis provided “kitbags” that included vitamins and drugs to be given directly to patients, in exchange for a $5 donation to the St. Joseph’s fund-raising arm. The bags benefited no doctor directly, raised money for charity and did not constitute a conflict, Ms. Hewitt concluded.

• Novartis proposed buying TVs for the waiting room of the institute’s “retina pod,” where macular degeneration is treated, along with educational videos that included material sponsored by the company and others. Dr. Hodge rejected the project, fearing patients seeing “biased” information, but it could have been implemented simply by controlling the video’s contents, said the lawyer.

• Novartis paid for another educational video, featuring three doctors who treat macular degeneration, about the condition and its treatments. The physicians got no personal gain, and did not plug one particular drug, said Ms. Hewitt.

— Novartis offered to fund a respected guest speaker from the U.S. and accompanying dinner for doctors and trainees, with a company rep at one point suggesting to a department employee exactly how much —$8,000 — the speaker should be paid. After much debate, the visiting expert ended up being paid less, from other sources.

— Ophthalmologists treating macular degeneration received an $18,000 grant from Novartis for training technicians, $5,000 for a “journal club,” $10,000 for a speaker series and $35,000 for a studentship. All the grants were unrestricted, and none represented a conflict of interest, the report concluded.

The review, released Wednesday, looked into allegations by Dr. William Hodge, until recently chairman of the Western University department, that the industry was exerting excessive and undue influence.

But lawyer Elizabeth Hewitt concludes there was, in fact, no conflict of interest involving doctors who belong to both the London university’s ophthalmology department and the Ivey Eye Clinic at St. Joseph’s Health Care.

The report also indicates Dr. Hodge lodged his complaints last year as he learned his job as department head would not be renewed, after he was accused of helping fuel a divisive atmosphere among the eye specialists.

“There has been and still exists a fragmented ophthalmology department. There are those who have supported Dr. Hodge and those who have opposed his leadership,” Ms. Hewitt wrote. “[But] it is my opinion [the drug company] has not had an excessive or unethical influence.”

The report’s conclusions are a validation of the department, and help clear the cloud that has hung over it, said Dr. Gillian Kernaghan, chief executive of St. Joseph’s.

“They felt there were accusations that spoke to their integrity,” she said. “It’s always a challenge when one member of a department makes accusations against other members of the department.”

The document does reveal routine interaction with and extended cash support from Novartis. Although the report does not name the company, its identity is clear from the context.

Novartis is at the centre of some controversy over the drug Lucentis, used to treat macular degeneration, which it distributes in Canada. Studies suggest Avastin, another older drug made by the same manufacturer, Roche, for treating colorectal cancer is just as effective for the eye disease as Lucentis, and costs a fraction of the price.

Just the perception of an inappropriate relationship can shake the confidence of patients

But Roche has not asked Health Canada to approve it for that purpose, meaning provincial drug plans refuse to cover its cost, prompting many doctors to prescribe pricier Lucentis.

Whether the firm’s influence was “excessive” or not, patients hearing about its ties to the department might question the physicians’ objectivity, argued Dr. Nav Persaud, a Toronto family physician and University of Toronto lecturer who studies the interaction between doctors and industry.

“Even just the perception of an inappropriate relationship can shake the confidence of patients,” he said. “Just raising that question in the mind of a patient is harmful to the clinic and harmful to medicine in general.”

Dr. Kernaaghan said a good rapport between academic physicians and industry is important, helping ensure, for instance, a new drug is monitored for its safety after being approved.

Dr. Hodge alleged in a May 2013 complaint influence by Novartis on his department had become “so severe,” an independent review was needed.

“I am not a consultant for any industry company and I am in no way influenced by industry; and that type of virgin industry ethics is very bad for a company,” he wrote.